Monday, February 25, 2013

Accountability in medical education

With CMS, HRSA and others investing close to $9 billion dollars annually
in graduate medical education, the day has now come for greater
accountability in graduate medical education around safety and quality.
Imagine what would happen if academic medical centers
were ”reimbursed” for their graduate medical education the same way
hospitals are now being reimbursed for patient care with penalties
for lapses in safety and quality education, similar to readmission or
infection rates. A reimbursement model based on Value-Based Education
and HCAHPS for graduate medical education…where organizations like
Consumer’s Union, Healthgrades and Leapfrog would publish
annual ”grades” for GME quality and safety programs across the
country. That would surely raise the stakes, get institutional
leadership’s attention, and change the graduate medical education
landscape. Is that type of educational “transparency” heading our way in
the not-too-distant future?

I'm just a lowly bedside (non-MD) clinician at a large AMC who happens to also follow our financials. As I've made my way through my MHA program I often wondered why the hospital seems to essentially send a blank check every year to the medical school for the physicians they supply us.

Even though we are in a relationship with only one medical school (and bear the same name), why should we not be holding them accountable for the physicians (and residents), when ultimately we are the ones who will be paid off the quality they deliver?

If Ford Motor Company is still held responsible for the quality of cars they deliver, even when its an independent auto dealer making the sale and providing post-sale services, then medical schools should bear the same responsibility to their end-users (the patients) and the AMC's they supply their physicians too.

So in my opinion, if an AMC is reimbursed a lesser amount because of low quality physicians, perhaps the the medical school should be reimbursing reimbursing a portion of that lower payment.

This is my first time to your blog, its great! Thanks! I am looking forward to your webinar.

We have a company in Baltimore, that is trying to bring business content learning to residents. It is amazing how much the hospital leaders side step their responsibility to add process of health care delivery to their residents curriculum. We have an extensive in person and on line seminar content that seems to be falling on deaf ears. My opinion is that health care will never get better, safer and cheaper until all physicians learn modern business principals such as process improvement and finance just to name a few. We have figured out how to deliver this contnet in a way that they can use.Follow us at www.es4p.com

Sounds like a good idea. However if these programs don't stick and stay and achieve what they set out to achieve, they get dropped along with the core ideas...safety and quality. Sounds like what happened when hospitals adopted Demmings' "do it right the first time". That quickly fell by the wayside. Once again the costs to maintain such program ate into the dirty word "profits", so the ideas turned to more "cost effective" ways of achieving "safety and quality". Now see what we've got! Neither!

Absolutely right! As a physician who graduated from Harvard and took initial internal medicine at the Beth Israel, albeit many years ago, I would have given both a very low grade for educational organization. More currently, I see nothing in medical education here in the Bay Area that focuses on organizing care, running a practice, introducing systems for higher quality, etc. Also, very little attention at all to the humanistic qualities of medicine that are the real core of caring for people. Alas!

I read this post shortly after absorbing Bob Wachter's post "Is the patient safety movement in danger of flickering out?" on his own blog, which has a great deal to say about caregiver burnout. Some of the comments are wails from Dante's Inferno. The more I read about the issues facing health care, the more I become convinced that concentrating solely on patient safety and quality is concentrating on the wrong problem, for the root cause of practically all health care issues, IMO, is a completely inadequate delivery system. If one can even call it a system, it has evolved piecemeal over years without design or forethought, and has been even further distorted by well-meaning, but bolted-on incentives and penalties. What's the use of educating medical students and residents in safety and quality if, when they start practice, they are thrown into a 'system' out of their control, which negates all efforts to make patients safer and quality higher? They will just burn out as noted in Bob's post. (see in particular Jim Conway's comment about the 'waterfall') We already know that students and residents suffer great declines in compassion for patients and idealism upon exposure to our 'system', even before they finish their training.

So what do I think of the idea? Yes, it will draw greater attention to the issue, but I fear it will just encourage teaching to the test and more bolted-on 'solutions' to individual safety issues by harried executives and leaders, which still do not address the underlying problem. Somehow we've got to get even deeper.